Chief Executive’s Message – Friday 27 March

March 27, 2020

I think it is probably right to devote today’s message to COVID-19 (my final paragraph is not about the pandemic!).  We held a webex team talk this week, and my usual video is shortly out.  Heartbeat is released next week.  There were three other topics in Teamtalk – mandatory training (are you in our 8% of folk who can do it online before Tuesday?), our Safety Plan work, and the launch of our learning GEMS.  All good stuff and worth a moment, because there are moments without COVID-19, and it is worth finding ways to not think about it.  All of us need to find space.  I took some time off earlier in the week, and whatever the huge challenges of the next eight weeks or four months we are trying really hard to insist on some time away on our rosters, and to create some annual leave scope.

Yesterday we changed our site security, or maybe it is our site psychology.  In basic terms, with help from our security team and outside contractors, as well as our volunteers, it is no longer possible for most folk not on our staff to enter the sites, either at Leasowes, Rowley Regis, the BTC, City, BMEC or Sandwell.  Remember that visiting inpatient relatives is now done by video phone in the main.  That approach is all about making sure that staying home is understood in our communities.  But it is also a moment when we recognise that everything is changed in our ways of working.  A discipline is now needed that divides spaces into hot and cold, COVID-19 and non-Covid, red and blue.  That discipline dictates PPE for staff safety.  Of course COVID-19 patients have other conditions, and non COVID patients may develop the virus.  Nonetheless, now we need, as we are in applying our triage tool in the community, to be thoughtful and careful about the people we are looking after.  That same thought and care must dictate how we support those giving frontline care in all our settings, working to get people essentials, safe journeys home, timely discharge, and reassurance even at a distance.

From listening to you, reading your emails, and talking to colleagues, the professionalism and anxiety of this situation is true in equal measure.  I am under no delusion that every part of our plans is working perfectly everywhere.  Getting PPE at City on Wednesday night when I did some “secret shopping” was not straightforward.  Once you ‘know the system’ it works.  But I don’t want anyone to go off shift feeling they need to squirrel away masks for tomorrow, nor scrubs.  I don’t want teams to be so worried that they deny PPE from their stock to porters, pharmacists, PTS colleagues, or the team next door.  On D18, Bryan Knight, and now at Rowley Regis and the Lyng we have stock centres.  You won’t get what you want, to be clear, you will get plenty of what the Royal Colleges and PHE say is needed.  And if, with the discipline I mentioned, you are in a corridor in FFP3, expect to be challenged – by any of us.  This is our stock and we need to use it wisely.

I have to be optimistic that in the week ahead our staff swab pause will be replaced by a local or national programme.  I am properly optimistic that the excellence of our critical care teams will see us expand into D16 and OPAU successfully.  But these moves into new spaces, or Nightingale field hospitals in this the Year of the Midwife and Nurse, are not just logistical exercises.  Our biggest test is how we maintain and sustain humanity and care in the week ahead and the weeks after that.  Care at a slight distance.  Care amid new circumstances and with new colleagues.  Care when one is scared, or certainly apprehensive.  None of us want to be spending our waking hours discussing body bag supplies, or thinking about how we expand critical care by 500%, 700% or more.  This is a unique situation.  We will come through it.  But we will be changed by it, as individuals, families, teams, and as an NHS.  We need to recognise and accept that, even as we refuse to accept an inevitability to the rising death rates that represent lost years of joy in the people we love.

The next week is our week of training and retraining.  Support packages for some medical staff have been issued through David Carruthers.  The programme for critical care is agreed, and our thanks to Helen Cope for finalising the ward based teaching.  In coming days a lot of colleagues will be asked to move role or base between one clinical service and another.  Then towards the end of next week, non-clinical colleagues may be asked to take on some work outside their normal remit later in April.  There are a series of waves of change, in essence, where the timing is mildly uncertain but the reality of the pandemic is foretold.  Of course those asked to do something different must have support, mentoring, buddies and work/life balance.  We are proceeding in the expectation that everyone will find a way to play their part.  Yet of course you should raise any concerns or requests for extra help as we move through the changes of coming days.

I recognise that some Trust key workers are worrying about their own or their loved ones’ income. I hope that the announcement made governmentally this week allay some worried.  For those being asked to change job remuneration will be protected.  For those, like our bank interpreters, whose outpatient work is no longer available we have made an offer to help move some of that expertise into inpatient settings as well as to preserve incomes.  You will be aware that construction work on site at the Midland Met and on the GP practice at Sandwell are both halted now.  We are working through the construction guidance to see what could be done safely in either case.  The Trust does offer support for people struggling with their debts or finances, and you can get that through our SWBH Benefits app and links on Connect.  If you are worried about your families’ finances do please make us of that service or wider governmental advice.

In any situation of crisis, even one on this scale, organisations go through phases.  We have come now towards the end of the plan phase.  Of course the plan will be adapted, but the basic framework of what we need to do and when and how is 80% formed.  The absolute leadership task for everyone who manages anyone in our Trust now is the communication phase; talking, listening, clarifying.  That is why a number of senior clinicians – Mark Anderson, Nik Makwana, Jawad Khan, Saket Singhal, Nicky Taylor and Julie Thompson – are out and about over coming days making sure that our PPE arrangements are understood and correspond with your lived experience.  Start with Red and Blue.  Across our sites, today at City and elsewhere this weekend, you will begin to see very clear colour coding for COVID-19 and non-covid areas.  Of course which is which and where will change, and frankly in the next week may very well change daily.  Likewise some lifts and other facilities are labelled distinguishingly too.  That determination to communicate and communicate and communicate has to be a huge part of our response in coming days.  It applies to us as peers and to leaders especially.  We will have colleagues who have returned from leave, who do not use email or Connect, or who are simply frightened by something they have seen or read.  Acknowledging the fear and trauma, as well as the excellence and camaraderie is part of our response now and will be part of what we need to do as an organisation for a long time to come.  Daily number announcements, whilst necessary, do not do justice to the individual stories of recovery, of loss, or of distress felt by relatives, colleagues and patients.

Even as I write this message, it is a slight struggle to know how to move onto to other subjects.  But to end this week’s post as I began it, there are important things happened outwith and beyond the pandemic.  Next week a large number of valued and important colleagues, many of many years standing, move from this Trust to the West Midlands Ambulance Service as patient transport services change organisation.  Colleagues will have some new clinical pathways which we will need to adjust to and of course the same employment rights under TUPE.  Even if uniforms change, friendships and alliances will not, and now, as ever we depend on the dedication of our PTS teams.  On Wednesday, primary care clinicians from Your Health Partnership join our Trust.  At a simple level it means that well over 5% of the medical staff of our Trust are now GPs.  10% of local residents have a GP whose service is part of our organisation.  Overnight, as it were, nothing changes.  But the opportunity to work better together is significant.  Learning from the experience of community colleagues who aligned with City and Sandwell over a decade ago, it can sometimes take time to end a sense of “them” and “us”.  So because this change is part of our long term 2020 Vision, and because a pandemic demands new responses from us, let’s very quickly be clear that we are both changed by joining with YHP.  Loads to learn and outcomes to improve.  Consistent with our #welearn programme!

Stay well please.  You should be very proud of what you, and we, do.